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20th International AIDS Conference (AIDS 2014)

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AIDS 2014 Snapshots: U.S. in the Lens, Sex Workers Refuse to Be Unseen, and Everyone's Got a Point of View

July 23, 2014

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Midway through the 20th International AIDS Conference (AIDS 2014), stigma and discrimination loom large as culprits, while funding concerns -- whether it's how to get more, or how to do a better job with what we've got -- remain very much in the mix.

With more and more webcasts of conference proceedings appearing, we'll soon have worldwide analysis and commentary from eager eyes and dedicated brains. In the meantime, here's a mix of what's popping up on our screens. You can find much more at TheBodyPRO.com's AIDS 2014 conference coverage page, on the AIDS 2014 YouTube channel, and beyond ...


Across the Planet but Not Off the Agenda: HIV in the U.S.

The HIV epidemic in the U.S. is not a focal topic for AIDS 2014, as opposed to the last conference, which was held in Washington, D.C., in 2012 and drew thousands to a civil disobedience protest at the White House. But whether it's the active presence of U.S. based people living with HIV, advocates and researchers (and one ex-president, Bill Clinton), or new data from the U.S. epidemic, the nation may be across the world from the conference, but it's not off the agenda.

In our second video dispatch from Mark S. King, you can see the indefatigable anti-HIV-criminalization activist Edwin Bernard gave a shoutout to U.S. activists for coming from behind to force some real progress against U.S. criminalization practices.

Here's a few quick hits on some other ways the U.S. has popped up in Melbourne:


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CDC: "Unequal Progress and Cause for Concern" About U.S. Youth

In June, the U.S. Centers for Disease Control and Prevention (CDC) issued a Morbidity and Mortality Weekly Report (MMWR) focused on the most recent Youth Risk Behavioral Surveillance survey (YRBS), showing that fewer teens were having sex, and fewer of them were using condoms.

CDC dove back into the 12 years of YRBS data for AIDS 2014, with Laura Kann, Ph.D., head of the School-Based Surveillance Branch in CDC's Division of Adolescent and School Health, presenting on "Unequal Progress and Cause for Concern: Differences in HIV-Related Risk Behavior Trends Among Subgroups of U.S. Adolescents, 1991-2013."

As Kann explained to AIDS.gov, "only about 1 in 5, or 22%, of U.S. high school students that are sexually experienced have ever been tested for HIV."

Here's the rest of the scorecard:

  • Overall, and in males and white students, total lifetime sex has gone down or leveled off, depending on period. But for female, black and Hispanic students, the prevalence of sex has increased.
  • There's been less multiple partners for female, black and Hispanic students. But overall and among male and white students, this decreased in some periods, leveled off and then, in white students, increased in the last four years.
  • Condom use went up from 1991 to 1999, but hasn't changed since then for males, white and Hispanic students, and has decreased among female and black students.

The abstract concluded that "while the gap has narrowed between white, black, and Hispanic students and some progress has been made in reducing HIV-related risk behaviors, decreases in condom use and unequal progress across sex and race/ethnicity subgroups is concerning and may help explain disproportionate rates of HIV infection among adolescents."

Neither this issue of the MMWR nor the AIDS 2014 data mention or analyze sexual identity of youth or their sexual contacts to look for differences between heterosexual, lesbian, gay or bisexual youth. That's because states, territories or local areas can decide whether or not to add optional questions about same-sex sexual contact and sexual identity. And many of them still chose not to, despite encouragement from CDC.

#LGBTMatters, anyone?


The "Mississippi Baby": Her Virus, and Her Region of the U.S.

Clearly, the implications of the reappearance of virus in the child known as the "Mississippi Baby" extend far beyond U.S. borders and could have global implications in the quest for a cure.

But at the heart of the story is one little girl whose contribution to scientific knowledge could save millions of lives, in an era in which cure research is finding its footing (and you can get an overview of cure-related presentations at AIDS 2014 by Anthony Fauci, M.D., and David Cooper, M.D., right here at TheBodyPRO.com).

Reporting on an update on the case at AIDS 2014, Gus Cairns of aidsmap.com noted that:

Phylogenetic testing showed that the HIV that had reappeared was identical to the HIV that had disappeared some 27 months earlier, and was 98% similar to her mother's HIV. This removed any lingering doubt that the girl might not actually have been infected in the first place but might simply have been passively carrying virus from her mother after being born. Its lack of genetic evolution from the previous sample also showed that it had not been replicating at a very low level in the girl's memory cells, but had probably been carried as a single piece of HIV DNA within a handful of memory cells, or even one cell, until some kind of immune stimulant such as another infection caused the cellular differentiation and the reappearance of an active infection.

The conference presentation confirmed that the child's viral load, under the influence of treatment, was rapidly dropping to undetectable.

But, having heard nothing about the Mississippi mother in the press coverage, several women living with HIV and perinatal care advocates in the U.S. have speculated that she may have lost custody of her child -- the fear of which, it has been shown, can actually keep low-income women and women of color away from prenatal care in the first place.

With direct relevance to the social and structural conditions in the U.S. South that may have led to the situation of a mother who cannot access or stay in care, Megan McLemore of Human Rights Watch took to the conference stage, saying that persistent and broad human rights violations in the U.S. South create an environment of risk.

As noted by TheBodyPRO.com editor Warren Tong, Human Rights Watch has been able to bring about changes on issues such as segregation of HIV-positive prisoners in Alabama and South Carolina, the use of condoms as evidence against sex workers in New Orleans, and access to clean syringes for drug users in North Carolina, but much remains to be done.

Meanwhile, though most of the HIV community's focus is in Australia this week, there are some other important stories happening here in the U.S. The courts have delivered conflicting rulings about whether tax funds can be used to subsidize Affordable Care Act (ACA) plans purchased on the Federal Exchange, and New York City appointed a devoted gay doctor who has brought HIV testing prevention to sex clubs and bathhouses as the new head of the city's massive Bureau of HIV/AIDS Prevention and Control.

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This article was provided by TheBodyPRO.com. It is a part of the publication The 20th International AIDS Conference.
 


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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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